Liver disease due to hepatitis C virus (HCV) infection is an important cause of morbidity in patients on dialysis and in transplant recipients. This proposal will examine several factors related to HCV disease: 1) The effect of pre- transplantation infection on the prevalence and severity of liver disease, graft and patient survival will be studied in renal transplant recipients. 2) The prevalence and severity of liver disease in patients infected with HCV who continue on dialysis will be compared with those who undergo renal transplantation. 3) The prevalence and subtypes of HCV infection among cadaver organ donors in different parts of the country and their impact on tests for screening of these donors and transmission of infection will be studied. 4) The safety of using organs from HCV-infected donors in recipients with pre-transplantation HCV infection or in unselected recipients will be examined. 5) The factors that influence the prevalence and incidence of HCV infection in hemodialysis units and the impact of dialysis room and dialyzer reuse strategies to control the transmission of HCV infection in the dialysis units will be explored. 6) The performance of different screening and confirmatory tests in identifying current HCV infection among dialysis and transplant patients will be evaluated. The results of these studies are expected to have a broad impact on transplantation policies concerning donor and recipient selection with regard to hepatitis C infection, and on dialysis room policies to retard the transmission of HCV within dialysis units.